Department of Internal Medicine, Dong-A University College of Medicine, Busan 602-103, South Korea.
World J Gastroenterol. 2012 Jul 14;18(26):3426-34. doi: 10.3748/wjg.v18.i26.3426.
To investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) using floxuridine (FUDR) in patients with advanced hepatocellular carcinoma (HCC) confined to the liver.
Thirty-four patients who had advanced HCC with unresectability or unsuccessful previous therapy in the absence of extrahepatic metastasis were treated with intra-arterial FUDR chemotherapy at our hospital between March 2005 and May 2008. Among the 34 patients, 9 patients were classified as Child class C, and 18 patients had portal vein tumor thrombus (PVTT). One course of chemotherapy consisted of continuous infusion of FUDR (0.3 mg/kg during day 1-14) and dexamethasone (10 mg on day 1, 4, 7 and 11), and this treatment was repeated every 28 d.
Two patients (5.9%) displayed a complete response, and 12 patients (35.3%) had a partial response. The tumor control rate was 61.8%. The median overall survival times were 15.3 mo, 12.4 mo and 4.3 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0392). The progression-free survival was 12.9 mo, 7.7 mo and 2.6 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0443). The cumulative survival differed significantly according to the Child-Pugh classification and the presence of PVTT. In addition to hepatic reserve capacity and PVTT, the extent of HCC was an independent factor in determining a poor prognosis. The most common adverse reactions to HAIC were mucositis, diarrhea and peptic ulcer disease, but most of these complications were improved by medical treatment and/or a delay of HAIC.
The present study demonstrates that intra-arterial FUDR chemotherapy is a safe and effective treatment for advanced HCC that is recalcitrant to other therapeutic modalities, even in patients with advanced cirrhosis.
研究氟尿苷（FUDR）肝动脉灌注化疗（HAIC）治疗局限于肝脏的晚期肝细胞癌（HCC）的疗效。
2005 年 3 月至 2008 年 5 月，我院对 34 例无法切除或既往治疗无效且无肝外转移的晚期 HCC 患者进行了经肝动脉 FUDR 化疗。34 例患者中，Child 分类 C 级 9 例，门静脉癌栓（PVTT）18 例。一个疗程包括 FUDR（第 1-14 天每天 0.3mg/kg）持续输注和地塞米松（第 1、4、7 和 11 天每天 10mg），每 28 天重复一次。
2 例（5.9%）完全缓解，12 例（35.3%）部分缓解。肿瘤控制率为 61.8%。Child A、Child B 和 Child C 级患者的中位总生存时间分别为 15.3、12.4 和 4.3 个月（P=0.0392）。无进展生存时间分别为 12.9、7.7 和 2.6 个月（P=0.0443）。Child-Pugh 分级和 PVTT 的存在与无进展生存显著相关。除了肝储备能力和 PVTT 外，HCC 的范围也是决定预后不良的独立因素。HAIC 最常见的不良反应是粘膜炎、腹泻和消化性溃疡病，但大多数并发症经药物治疗和/或 HAIC 延迟后得到改善。
本研究表明，对于其他治疗方法无效的晚期 HCC，即使是在晚期肝硬化患者中，经肝动脉 FUDR 化疗也是一种安全有效的治疗方法。
